Healthcare Provider Details

I. General information

NPI: 1558443903
Provider Name (Legal Business Name): HOMAYOUN LEON DANESCHVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 SAN MIGUEL DR STE 306
NEWPORT BEACH CA
92660-7809
US

IV. Provider business mailing address

21163 NEWPORT COAST DR # 119
NEWPORT COAST CA
92657-1123
US

V. Phone/Fax

Practice location:
  • Phone: 949-805-1351
  • Fax: 949-805-1194
Mailing address:
  • Phone: 949-805-1351
  • Fax: 949-805-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC54336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: